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Validation of Psychosocial Factors as Predictors of Medication Adherence among Veterans following Hospitalization for Acute Coronary Syndrome Open Access

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The current study was an analysis of a randomized clinical trial of a multifaceted intervention to improve adherence to cardiac medications. This study sought to validate selected psychosocial factors as predictors of medication adherence among veterans hospitalized for an Acute Coronary Syndrome event. The participants in this study were recruited from four Veterans Administration medical centers in the United States. This study was grounded in the Social Cognitive Theory as the basis for exploring the role of medication-taking self-efficacy as a predictor of medication adherence behaviors. The primary psychosocial variables of interest included self-efficacy, depression, cognitive functioning and health literacy. The outcome variable in this study was patient's overall medication adherence to cardioprotective medications prescribed at hospital discharge. This study was guided by a conceptual framework that examined how the separate but interrelated and reciprocally influencing variables of cognitive function, health literacy and depression, impacted self-efficacy which, in turn, was predicted act as a determinant of medication adherence. In this study, self-efficacy was found to be a significant independent predictor of medication adherence. Patients with high self-efficacy had higher odds of being adherent than patients with lower self-efficacy, after controlling for the other predictor variables in the model. Health literacy, depression and cognitive functioning were not found to predict medication adherence in this study. However, considering the prevalence of depression and cognitive impairment within this sample of veterans, future research should examine these psychosocial factors in a larger veteran population and, perhaps, in the population at large. With the knowledge that medication adherence is a multi-dimensional problem, future interventions to improve medication-taking behaviors should integrate existing health behavior models that can provide a framework for isolating recognized triggers of behavior and applying strategies to deal with them in an effort to drive and sustain behavior change. Improving general awareness and enhanced evaluation of patients' personal, behavioral, and environmental factors will enable healthcare providers to make appropriate treatment recommendations that take into consideration based on the specific needs of their patients.

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